With limited supervision, coordinates and conducts validation review, assessment and applies appropriate query and/or modification to practitioner submitted medical code assignments. Participates in trend identification and analysis on an ongoing basis, regarding TSPMG practitioners, and additional clinical areas as requested, utilizing established documentation and coding criteria. These include but are not limited to; application of documentation standards; validation of health record completeness; process studies and verification; state and federal regulatory, accrediting audits, coding compliance and documentation analysis and validation; etc. Concurrent analysis of coding of Kaiser Permanente commercially billable encounters and procedures, providing coding selection support through professional interpretation of AHA, AMA, and CMS guidelines. Uses professional judgment and applies internal policy and procedure standards to complete query / communication with practitioners. Performs validations and prepares queries for practitioners on their medical service / clinical documentations and code assignments to ensure that KPSE (Georgia) receives appropriate reimbursement while conforming to all applicable guidelines, regulations, and standards (Federal, State, and internal). Travel required less than 10%. Candidates must be committed to maintaining the highest quality and production standards.
Essential Responsibilities:
Data / documentation and coding validation and analysis.
Authorized to modify assigned codes based on clinical documentation review, coding guidelines and queries / issues requiring clarification by clinician.
Participates with some supervision in test environments as UAT candidates (user acceptance testing).
Document and present analysis to leadership on a project basis.
Supports specialty-specific training to practitioners on documentation of services, appropriate coding of level of service, diagnosis and procedures code assignments through interpretation of appropriate coding guidelines.
Supports training at the department, team, or individual level as needed.
Maintains up-to-date knowledge regarding professional health information practices, as well as standards and regulatory requirements related to health information management and coding compliance (Federal, State, internal).
Supports team members who participate in task force groups regarding health information and coding issues.
Basic Qualifications:
Experience
Minimum five (5) years of direct coding assignment and validation experience.
Education
Associates degree or two (2) years of college level courses in health information, business administration, information systems, healthcare delivery or another related field.
May substitute degree for years of related experience.
License, Certification, Registration
Certified Professional Coder - Hospital Outpatient from American Academy of Professional Coders OR Certified Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders OR Certified Coding Specialist - Physician Based from the American Health Information Management Association
Additional Requirements:
Must attain and maintain ninety five (95)% accuracy level within one (1) year of hire.
Maintains less than five (5)% error rate within six (6) months of hire.
Working knowledge of medical terminology, anatomy, and pathophysiology.
Excellent interpersonal and communication skills (verbal and written).
Strong time management and analytical skills.
Ability to meet deadlines.
Ability to develop and use spreadsheets (MS Excel).
Ability to write reports summarizing identified trends, analysis of findings and recommendations.
Ability to follow appropriate methodology, sample selections, basic interpretation of results and formulation of appropriate recommendations.
Preferred Qualifications:
Minimum three (3) years of work experience in an outpatient healthcare setting utilizing electronic medical records and coding processes.
Minimum one (1) year of experience directly supporting clinician training needs related to interpretation of documentation and coding guidelines including research, developing and delivering detailed examples in a positive and supportive manner.
Completion of an AHIMA recognized coding certification program.
Bachelors degree in related field.
RHIT / RHIA through AHIMA.
Credentialed as a CPC / CPC-H or other specialized certifications to demonstrate advancement eligibility and subject matter expertise as approved by management.